{"id":"F2025L00723","name":"Statement of Principles concerning adjustment disorder (Balance of Probabilities) (No. 59 of 2025)","slug":"statement-of-principles-concerning-adjustment-disorder-balance-of-probabilities-no-59-of-2025","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442862,"registerId":"F2025L00723-fast-fetch-1775957792343","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning adjustment disorder (Balance of Probabilities) (No. 59 of 2025)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n![RMA Australian Government Coat of Arms](image.001.jpeg)\n\n \n\nStatement of Principles\n\nconcerning\n\nADJUSTMENT DISORDER  (Balance of Probabilities)\n\n(No. 59 of 2025)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n \n\nDated 20 June 2025\n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\nProfessor Terence Campbell AM\n\nChairperson\n\nby and on behalf of\n\nThe Repatriation Medical Authority\n\n \n\n   \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Repeal\n\n5 Application\n\n6 Definitions\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n8 Basis for determining the factors\n\n9 Factors that must exist\n\n10 Relationship to service\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nSchedule 1 - Dictionary\n\n1 Definitions\n\n \n\n \n\n\n\n\n1.                Name\n\n\nThis is the Statement of Principles concerning adjustment disorder (Balance of Probabilities) (No. 59 of 2025).\n\n1.                Commencement\n\n\n              This instrument commences on 21 July 2025.\n\n1.                Authority\n\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning adjustment disorder (Balance of Probabilities)(No. 24 of 2016) (Federal Register of Legislation No. F2016L00270) made under subsections 196B(3) and (8) of the VEA is repealed.\n\n1.                Application\n\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies.\n\n1.                Definitions\n\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n1.                Kind of injury, disease or death to which this Statement of Principles relates\n  1.           This Statement of Principles is about adjustment disorder and death from adjustment disorder.\n\n\nMeaning of adjustment disorder\n\n1.           For the purposes of this Statement of Principles, adjustment disorder: means a disorder of mental health meeting the following diagnostic criteria (derived from DSM-5-TR):\n  1.           the development of emotional or behavioural symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s);\n  2.           these symptoms or behaviours are clinically significant, as evidenced by one or both of the following:\n    1.             marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation; \n    2.          significant impairment in social, occupational, or other important areas of functioning;\n  3.           the stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder;\n  4.           the symptoms do not represent normal bereavement;\n  5.           once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months.\n\n\nNote: DSM-5-TR is defined in the Schedule 1 – Dictionary\n\n1.           While adjustment disorder attracts ICD‑10‑AM code F43.2, in applying this Statement of Principles the meaning of adjustment disorder is that given in subsection (2).\n2.           For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.\n\n\nDeath from adjustment disorder\n\n1.           For the purposes of this Statement of Principles, adjustment disorder, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's adjustment disorder.\n\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.                Basis for determining the factors\n\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that adjustment disorder and death from adjustment disorder can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.\n\nNote: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.\n\n1.                Factors that must exist\n\n\nAt least one of the following factors must exist before it can be said that, on the balance of probabilities, adjustment disorder or death from adjustment disorder is connected with the circumstances of a person's relevant service:\n\n1.           experiencing a category 1A stressor within the 3 months before clinical onset;\n\n\nNote: category 1A stressor is defined in the Schedule 1 – Dictionary.\n\n1.           experiencing a category 1B stressor within the 3 months before clinical onset;\n\n\nNote: category 1 B stressor is defined in the Schedule 1 - Dictionary.\n\n1.           being exposed to repeated or extreme aversive details of severe traumatic events within the 3 months before clinical onset;\n\n\nNote: for example, first responders collecting human remains or drone operators viewing planned strikes, repeatedly listening to a person’s account of their exposure to severe traumatic events. This includes media exposure of the traumatic event (for example, electronic media, television images or photographs) where viewing these images is a requirement of service.\n\n1.           having a person with whom one has a close family bond or a close personal relationship experience a category 1A stressor within the three months before clinical onset;\n\n\nNote: category 1A stressor is defined in the Schedule 1 – Dictionary.\n\n1.           experiencing a category 2 stressor within the 3 months before clinical onset;\n\n\nNote: category 2 stressor is defined in the Schedule 1 – Dictionary.\n\n1.           having a medical illness or injury which has resulted in a severe level of physical or cognitive disability, within the 3 months before clinical onset;\n\n\nNote: clinical onset is defined in the Schedule 1 - Dictionary.\n\n1.           having a miscarriage, foetal death in-utero or stillbirth, within 3 months before clinical onset;\n\n\nNote: miscarriage is defined in the Schedule 1 - Dictionary.\n\n1.           inability to obtain appropriate clinical management for adjustment disorder before clinical worsening.\n\n\n1.            Relationship to service\n  1.           The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.\n  2.           The factor set out in subsection 9(7) applies only to material contribution to, or aggravation of, adjustment disorder where the person's adjustment disorder was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n2.            Factors referring to an injury or disease covered by another Statement of Principles\n\n\nIn this Statement of Principles:\n\n1.           if a factor referred to in section 9 applies in relation to a person; and\n2.           that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(3) of the VEA;\n\n\nthen the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.\n\n \n\n \n\nSchedule 1 - Dictionary  \n\nNote:               See Section 6\n\n1               Definitions\n\nIn this instrument:\n\n                               adjustment disorder—see subsection 7(2).\n\n                                category 1A stressor means one of the following severe traumatic events:\n\n(a)          experiencing a life-threatening event;\n\n(b)          being subject to a serious physical attack, or assault including rape or sexual molestation; or\n\n(c)          being threatened with a weapon, being held captive, being kidnapped, or being tortured. \n\n                               category 1B stressor means one of the following severe traumatic events:\n\n(a)          killing or maiming a person;\n\n(b)          being a witness to a person being killed or critically injured;\n\n(c)          being a witness to atrocities inflicted on another person;\n\n(d)          being a witness to human remains or a critically injured casualty.\n\nNote: witness is defined in the Schedule 1 – Dictionary.\n\n                               category 2 stressor means one of the following negative life events, the effects of which are chronic in nature and cause the person to feel on-going distress, concern or worry:\n\n(a)          being a full-time caregiver to a family member or a person with whom one has a close family bond or a close personal relationship with a severe physical, mental or developmental disability;\n\n(b)          being socially isolated and unable to maintain friendships or family relationships, due to physical location, language barriers, disability, or medical or psychiatric illness;\n\n(c)          experiencing adverse prejudicial differential treatment or unequal access to opportunities based on membership to a particular sociocultural group (racism);\n\n(d)          experiencing a problem with a long-term relationship including the break-up of a close personal relationship, the need for marital or relationship counselling, marital separation, or divorce;\n\n(e)          having concerns in the work environment including on-going disharmony with fellow work colleagues, perceived lack of social support within the work environment, perceived lack of control over tasks performed and stressful workloads, or experiencing bullying in the workplace or school environment;\n\n(f)           experiencing prejudice or discrimination based on gender, or behaviour or attitudes that foster stereotyped social roles based on gender (sexism);\n\n(g)          experiencing serious legal issues including being detained or held in custody, on-going involvement with the police concerning violations of the law, or court appearances associated with personal legal problems;\n\n(h)          having severe financial hardship including loss of employment, long periods of unemployment, foreclosure on a property or bankruptcy;\n\n(i)            having a family member or a person with whom one has a close family bond or a close personal relationship experience a major deterioration in their health.\n\n \n\n                               Clinical onset means the point backwards in time from the date of presentation to a registered medical practitioner first confirming the presence of the illness or injury, to the date at which the symptoms of illness or injury were persistently present, as assessed by a registered medical practitioner.\n\n                               DSM-5-TR means the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Text Revision Washington, DC, American Psychiatric Association, 2022.\n\n                               miscarriage means the spontaneous or induced expulsion of the products of conception from the uterus before the foetus is viable.\n\n                               MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n                               relevant service means:\n\n(a)          eligible war service (other than operational service) under the VEA;\n\n(b)          defence service (other than hazardous service and British nuclear test defence service) under the VEA; or\n\n(c)          peacetime service under the MRCA.\n\nNote: MRCA and VEA are defined in the Schedule 1 - Dictionary.\n\n                               terminal event means the proximate or ultimate cause of death and includes the following:\n\n(a)           pneumonia;\n\n(b)           respiratory failure;\n\n(c)           cardiac arrest;\n\n(d)           circulatory failure; or\n\n(e)           cessation of brain function.\n\n                               VEA means the Veterans' Entitlements Act 1986.\n\n                               witness means a person who experiences an incident firsthand and can give direct evidence of it. This excludes persons exposed only to public broadcasting or mass media coverage of the incident.\n\n                                \n\n \n\n \n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement/update of an existing Statement of Principles (repealing No. 24 of 2016). It maintains the same scope: establishing medical criteria for linking adjustment disorder to military service. The content reflects updated medical standards (DSM-5-TR) and expanded examples of stressors, but does not represent scope creep beyond the original purpose of determining service connection for this specific condition."},"complexity_factors":["14 defined terms in Schedule 1, including nested definitions (e.g., 'category 1A stressor' contains 3 sub-categories, 'category 1B' contains 4, 'category 2' contains 9)","Cross-references to external medical classification systems (DSM-5-TR, ICD-10-AM)","Temporal requirements throughout (multiple references to 'within 3 months before clinical onset')","Conditional logic in section 10(2) limiting application of one factor to aggravation cases only","Incorporation by reference of other Statements of Principles in section 11","Specific diagnostic criteria in section 7(2) with 5 enumerated conditions that must all be met"],"plain_english_summary":"This instrument sets medical criteria for when Australian veterans and current or former defence members can claim compensation for adjustment disorder, aligning the definition with DSM‑5‑TR and specifying service‑connected factors that can link the condition to military service.\n\nIt matters because it determines entitlement decisions under the VEA and MRCA, replaces the 2016 guidance, and applies a \"balance of probabilities\" test — making it the guiding standard for assessing claims."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This 2025 Statement expands the range of qualifying stressors and outcomes compared with a narrowly trauma‑focused approach. Notable broadening elements include: explicit inclusion of category 2 chronic/social stressors (eg, caregiving, workplace disharmony, racism and sexism, long‑term financial hardship) in the primary list of qualifying factors (Schedule: category 2); explicit inclusion of inability to obtain appropriate clinical management as a qualifying factor for material contribution or aggravation (s.9(8); s.10(2)); and a clear inclusion of death where a terminal event was contributed to by adjustment disorder (s.7(6); Schedule: terminal event). The Statement also updates the diagnostic benchmark to DSM‑5‑TR (Schedule), and repeals the 2016 Statement. Together, these changes broaden the circumstances in which a service connection may be established, which is likely to increase the types of claims that pass the Statement’s threshold and to raise administrative and evidentiary demands on decision makers and claimants."},"complexity_factors":["12 defined terms in Schedule 1 (adjustment disorder, category 1A stressor, category 1B stressor, category 2 stressor, clinical onset, DSM‑5‑TR, miscarriage, MRCA, relevant service, terminal event, VEA, witness)","Clear, short list structure: a single sufficiency test requiring at least one qualifying factor (s.9)","Uniform timing rule (3 months before clinical onset) for most factors, reducing conditional branching (s.9)","Cross‑reference to external diagnostic standard (DSM‑5‑TR) and to ICD‑10‑AM coding, requiring alignment with clinical practice (s.7(2), s.7(4))","Interaction with other Statements of Principles (s.11) creates cross‑instrument dependency","Subjective clinical judgments required (terms like \"clinically significant\", \"marked distress\", \"out of proportion\", and establishing \"related to service\") increase interpretive complexity","Special rule for factor 9(7) (inability to obtain clinical management) limiting its application to pre-existing or during‑service disorders, which is an exception to the general relationship rule (s.10(2))","Inclusion of both acute trauma categories (1A/1B) and chronic social/work stressors (category 2) expands factual variety decision makers must consider (Schedule)"],"plain_english_summary":"**What this instrument is and who it affects**\n\n- This is a medical-legal rule (a \"Statement of Principles\") produced by the Repatriation Medical Authority that sets out when \"adjustment disorder\" and death contributed to by adjustment disorder can be treated as connected with a person’s Australian defence service for the purposes of veterans’ compensation law (the VEA and MRCA). (See sections 1, 3, 5 and 7.)\n\n**How it works, mechanically**\n\n- The Authority says that, on the balance of probabilities (more likely than not), adjustment disorder can be related to service if at least one of the specified factors existed before the clinical onset of the disorder. (s.8, s.9)\n\n- Timing rule: the listed factor must have occurred within 3 months before the clinical onset of the adjustment disorder, unless an alternate timing rule is stated. \"Clinical onset\" is defined as the point backwards from first medical confirmation to when symptoms were persistently present. (s.9, Schedule definition of clinical onset)\n\n- The set of qualifying factors (any one is sufficient) are: (s.9)\n  - experiencing a category 1A stressor (severe traumatic events such as life‑threat, serious assault, torture); (Schedule: category 1A)\n  - experiencing a category 1B stressor (events such as killing/maiming another person, witnessing death/critical injury, seeing human remains); (Schedule: category 1B)\n  - exposure to repeated or extreme aversive details of severe traumatic events (for example, repeated viewing of traumatic images, or repeatedly hearing first‑hand accounts) where that exposure occurred within 3 months before clinical onset; (s.9(3))\n  - a close family member or close personal relation experiencing a category 1A stressor within 3 months before the person’s clinical onset; (s.9(4))\n  - experiencing a category 2 stressor (chronic negative life events such as long‑term caregiving, social isolation, workplace disharmony or bullying, racism, sexism, serious legal issues, severe financial hardship, or a close other’s major health deterioration); (Schedule: category 2)\n  - having a medical illness or injury causing severe physical or cognitive disability within 3 months before clinical onset; (s.9(6))\n  - having a miscarriage, foetal death in‑utero or stillbirth within 3 months before clinical onset; (s.9(7))\n  - inability to obtain appropriate clinical management for adjustment disorder before clinical worsening. (s.9(8))\n\n- The Statement uses the DSM‑5‑TR diagnostic criteria to define \"adjustment disorder\" (for example, symptoms beginning within 3 months of an identifiable stressor, clinically significant distress or impairment, exclusion of other disorders, not normal bereavement, and symptoms usually not persisting more than 6 months after the stressor ends). (s.7(2); Schedule: DSM‑5‑TR)\n\n- Death: the instrument explicitly includes death that was contributed to by a person’s adjustment disorder (death from a terminal event or condition to which adjustment disorder made a contribution). (s.7(6); Schedule: terminal event)\n\n- Relationship to service: any factor relied on must be related to the person’s \"relevant service\" (the specified categories of defence service defined in the Schedule). One listed factor (the inability to obtain appropriate clinical management) only applies to cases where the disorder pre‑existed or was suffered during service but did not arise out of service, and then only for material contribution or aggravation. (s.10)\n\n- Interaction with other Statements: if a listed factor refers to an injury/disease covered by another Statement of Principles, the rules in that other Statement apply as well. (s.11)\n\n**Why it matters (official purpose and practical implications)**\n\n- Officially, the Authority takes the position that there is sufficient medical‑scientific evidence that adjustment disorder and death from adjustment disorder can be related to relevant service on the balance of probabilities. That view is what enables decision makers under the VEA/MRCA to accept service connection when the Statement’s tests are met. (s.8)\n\n- Who decides and who pays: the Repatriation Medical Authority sets these medical criteria; claims assessors in government agencies (eg, the Department of Veterans’ Affairs under the VEA or MRCA processes) apply them to decide eligibility for veterans’ entitlements and compensation, which are paid by the Commonwealth under those Acts. (ss.3, 5; Schedule: VEA, MRCA)\n\n**Consequences for behaviour, evidence and administration**\n\n- Claimants will need to provide evidence showing the timing of stressors relative to clinical onset, medical confirmation meeting DSM‑5‑TR criteria, and a link between the stressor and the person’s relevant service. (s.7(2), s.9, s.10)\n\n- Clinicians will be asked to assess \"clinical onset\" and whether symptoms are \"clinically significant\" and not better explained by another disorder — these assessments involve clinical judgment and record‑keeping aligned to DSM‑5‑TR criteria. (s.7(2); Schedule)\n\n- Administratively, the timing window (3 months) and the requirement that at least one of the listed stressor categories be present concentrate decision points on (a) verifying the nature of the stressor, (b) establishing its relationship to service, and (c) determining the date of clinical onset. (s.9; Schedule: clinical onset)\n\n**Costs, incentives and trade‑offs to note**\n\n- Benefit scope: the Statement broadens qualifying stressors beyond single traumatic events to include chronic social and work‑related stressors (category 2) and inability to access care. That expands the range of circumstances that can give rise to a compensable service connection (Schedule: category 2; s.9(8)).\n\n- Administrative/compliance cost: broader categories and subjective clinical judgments (\"marked distress\", \"out of proportion\", \"clinically significant\") increase the volume and complexity of medical and documentary evidence needed, and elevate the role of clinical interpretation. This raises decision time and potential for appeals. (s.7(2); s.9)\n\n- Implementation risk and discretion: the instrument gives assessors scope to evaluate close‑relationship claims, cultural context when judging proportionality, and whether a stressor \"relates to\" service. Those assessments can be discretionary and fact‑specific, creating uncertainty for claimants and providers. (s.7(2)(a); s.10)\n\n- Effects on non‑government actors: employers and private health providers may see more involvement in evidence for workplace or caregiving‑related claims (category 2). Private mental health and legal services may see increased demand as claimants seek assessments and representation. The Statement does not itself create regulatory obligations for private employers, but it makes workplace factors actionable in veterans’ compensation claims. (Schedule: category 2; s.9)\n\n- Potential for concentrated benefit and diffuse cost: expanded categories primarily benefit claimants with chronic or social stressors and those who lacked prompt clinical care; costs of processing, treatment and compensation are borne by the Commonwealth. That creates incentives for claimants to document service links and for providers to support claims through clinical evidence. (s.9; s.10)\n\n**Net effect, mechanically stated**\n\n- If a veteran or member shows (on the balance of probabilities) that a qualifying stressor from the list occurred within 3 months before clinical onset, and that stressor is related to their relevant service, decision makers can accept a service connection for adjustment disorder (or death contributed to by adjustment disorder) under the VEA/MRCA. The expanded list of qualifying stressors and the inclusion of inability to obtain clinical care broaden the circumstances where such a connection may be found. (s.7, s.8, s.9, s.10)\n\n"},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-adjustment-disorder-balance-of-probabilities-no-59-of-2025","history":"/api/acts/statement-of-principles-concerning-adjustment-disorder-balance-of-probabilities-no-59-of-2025/history","analysis":"/api/acts/statement-of-principles-concerning-adjustment-disorder-balance-of-probabilities-no-59-of-2025/analysis","conflicts":"/api/acts/statement-of-principles-concerning-adjustment-disorder-balance-of-probabilities-no-59-of-2025/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-adjustment-disorder-balance-of-probabilities-no-59-of-2025/important-cases","documents":"/api/acts/statement-of-principles-concerning-adjustment-disorder-balance-of-probabilities-no-59-of-2025/documents"}}